Provider Demographics
NPI:1295950368
Name:GIBBON, CHRISTINE A (PHD LP LLC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:GIBBON
Suffix:
Gender:F
Credentials:PHD LP LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 E BLOOMINGTON FWY STE 117
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3487
Mailing Address - Country:US
Mailing Address - Phone:952-406-8132
Mailing Address - Fax:952-456-6368
Practice Address - Street 1:9001 E BLOOMINGTON FWY STE 117
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3487
Practice Address - Country:US
Practice Address - Phone:763-595-7294
Practice Address - Fax:763-595-7293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4789103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service